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A  N 

INAUGURAL  DISSERTATION 

ON    THE 

INFLUENZA. 


SUBMITTED  TO  THE  PUBLIC  EXAMINATION 
OF     THE 

FACULTY    OF    PHYSIC, 

UNDER    THE    AUTHORITY    OF    THE 

TRUSTEES  OF  COLUMBIA  COLLEGE, 

IN     THE 

STATE  OF  NEW-YORK, 
WILLIAM  SAMUEL  JOHNSON,  LL.  D.   Prefident; 

FOR    THE    DEGREE    OF 

DOCTOR     OF     PHYSIC, 

ON  THE  SIXTH  DAY  OF  MAY,    1794. 


By     PETER     IRVING, 

Citizen  of  the  State  of  New- York. 


Maxima  pars  hominum  morbo  ja&atur  eodem. 

Horacj 


NEW-YORK: 

Printed  by  T.  and  J.  Swords,  Printers  to  the  Faculty  of  Phyfic  of 
Columbia  College,  No.  167,  William-Street. 


\JnLj-t 


CX5 


T   O 

His  Excel.  GEORGE  CLINTON, 

Governor  of  the  State  of  New- York ; 

Whofe  long  and  faithful  Services  to  his  Country, 
Whofe  ileady  Attachment  to  the  Caufe  of  Liberty, 

AND, 

Whofe  Virtues  as  an  Individual  rauft  endear  him  to 
every  American ; 

THIS 

DISSERTATION 

Is  infctibedj 

With  the  warmed  Sentiments  of  Refpe£i  and  Efteem, 
By  his  mofl  obedient  Servant, 

The  AUTHOR. 


T  O 

JOHN  BROOME,  Prefident, 

AND 

ISAAC  STOUGHTENBURGH, 

JOHN  CAMPBELL, 

THEOPHILUS  BEEKMAN, 

GABRIEL  FURMAN, 

GEORGE  JANEWAY, 

NICHOLAS  CARMER, 

FREDERICK  STYMETS, 

ROBERT  BOWNE, 

WHITE  MATLACK, 

NATHANIEL  HAZARD, 

ROBERT  LENOX, 
Dr.  MALACHI  TREAT, 
Dr.  SAMUEL  BARD, 

Who  compofe  the  Committee  of  Health. 

Gentlemen, 


t 


HE  firm  and  determined  manner  in  which  you 
executed  the  arduous  truft  lately  confided  to  you,  and 
the  fervice  you  have  rendered  the  community  by,  in 
all  probability,  preferving  this  city  from  the  dreadful 
calamity  with  which  a  neighbouring  one  was  fo  lately 
afflicted,  deferve  the  grateful  acknowledgements  of 

your 


(     6     ) 

your  fellow-citizens:  while  your  humanity,  in  tem- 
pering neceffary  ftridtnefs  with  companion,  and  pre- 
fenting  the  mod  timely  and  effential  afliftance  to  the 
difconfolate  fufFerers,  enfure  you  their  efteem. 

Emboldened  by  the  numerous  marks  of  politenefs 
and  attention  which  I  received  while  ferving  under 
your  direction,  I  have  taken  the  liberty  of  foliciting 
a  renewal  of  your  patronage,  and  of  addreffing  to  you 
this  trifling  production,  which  will  need  all  your 
candour  and  all  your  indulgence. 

It  is  with  pleafure  that  I  confers  myfelf  under  pecu- 
liar obligations  to  one  member  of  your  refpedtable 
body—  Dr.  Malachi  Treat  ;  not  only  for  the  in- 
formation I  have  received  from  him  in  the  fcience  of 
medicine,  but  alfo  for  the  many  teftimonies  of  his 
friendfhip  which  I  have  repeatedly  experienced. 

To  merit,  gentlemen,  a  continuance  of  your  ap- 
probation, will  ever  be  my  higheft  wifli. 

I  am, 
With  the  greateft  refpeel:, 
Your  much  obliged  fervant, 

The  AUTHOR. 
PREFACE. 


PREFACE. 


HE  difficulties  under  which  a  young  man 
labors,  who  writes  for  public  inspection,  are 
numerous  and  difcouraging ;  but  the  Medical 
Graduate  is  furrounded  by  peculiar  difad  vantages. 
Having  as  yet  formed  none  but  undigefted 
opinions,  the  remit  of  a  flight,  and,  at  beft,  but 
fuperficial  knowledge  of  medicine;  opinions  of 
which  a  few  years  increafe  of  information  may 
perhaps  render  him  afhamed  \  he  is  obliged  to 
expofe  them  to  the  view  of  the  public,  who  pof- 
fefs  no  other  criterion  by  which  to  judge  of  his 
abilities. 

Agreeably,  however,  to  the  regulations  of  the 
Univerfity,  I  here  fubmit  to  the  perufal  of  my 
fellow-citizens  the  hafty  production  of  a  very  few 
days  \  trusting  that,  when  all  circumftances  are 
confidered,  it  will  be  received  with  indulgence. 


DISSERTATION 


ON    THE 


INFLUENZA, 


I 


.T  is  an  old  and  well  eftablifTied  adage,  that  cuftom 
reconciles  all  things.  The  univerfal  prevalence  of 
evil  has  long  fince  habituated  the  world  to  its  uncom- 
fortable effects.  Difeafe  itfelf,  though  always  an  un- 
welcome vifitor,  has  become  an  old  acquaintance; 
and  thofe  complaints,  not  generally  fatal,  which  are 
moft  common,  are  at  length  fo  familiarifed  to  our 
ideas  by  the  frequency  of  their  occurrence,  that 
while  abfent,  they  are  rarely  dreaded,  and  when  felt, 
are  commonly  difregarded. 

Among  difeafes  of  this  defcription,  to  which  we 

are  moft  accuftomed,  may  catarrh  be  reckoned;  and 

as  it  not  unfrequently  lays  the  foundation  of  diforders 

of  a  more  ferious  and  alarming  nature,  it  merits  the 

B  ftri6bft 


(      io     ) 

ftridleil  attention,  notwithstanding  the  neglect  it  too 
often,  and  indeed  almoft  always  receives.  From  the 
flighted  view  of  the  caufes  which  induce  catarrh,  it 
appears  evident,  that  it  has  not  lately  commenced  its 
exiftence,  but  that  mankind  have  ever  been  fubjecT: 
to  its  evils,  fince  they  were  firft  expofed  to  viciflkudes 
of  cold  and  heat. 

Syftematic  writers  have  divided  it  into  two  fpecies. 

,r.  The  ordinary  catarrh,  or  common  cold. 

2.  The  contagious  catarrh,  commonly  known  by 

the  term  Influenza. 
To  the  consideration  of  the  latter  I  mean  at  prefent 
to  confine  myfelf. 

The  influenza  extends  over  vaft  tracts  of  country, 
and  univerfally  attacks  the  inhabitants  of  thofe  places 
in  which  it  prevails. 

The  ehara&eriftic  fymptoms  are  an  inereafed  dif- 
-•charpe  of  muc«s  from  the  fchneiderian  membrane, 
accompanied  with  a  fever  of  a  contagious  nature. 

The  accounts  we  have  received  of  its  appearance 
as  an  epidemic,  extend  as  far  back  as  the  earlieft 
ao-tfs  of  medicine  ;  it  has  fince  frequently  recurred, 
and  has  always  been  attended  with  fimilar  fymp- 
toms, though  defcribed  under  very  different  names. 
It  was  more  univerfal  in  Europe  in  1781  and 
1782  than  it  had  ever  been  known  before,  and  was 
then  fuppofed  to  have  been  brought  from  the  Eaft- 
Tndies  to  Ruffia,  and  thence  to  have  pafled  to  every 

part 


(  II  ) 

£>art  of  Europe  in  fucceffion.*  In  1789  it  appeared 
in  the  ifland  of  Jamaica;  and  in  the  autumn  of 
$790  the  inhabitants  of  New-York  were  pretty 
ieverely  affected  with  it. 

It  feemed  to  pafs  over  the  country  without  obferving 
any  particular  direction, f  allowing  few  to  efcape  its 
attacks;  and  returned  in  the  fpring  of  1791  with 
unabated  violence.  Its  progrefs  was  rapid,  and  though 
an  immenfe  number  of  perfons  were  affected,  the 
termination  was  very  rarely  fatal 0 

In  the  autumn  of  1793  the  influenza  was  again 
obferved  in  this  place,  with  fymptoms  fimilar  to  thofe 
which  marked  its  former  occurrence. %  The  fame 
perfon  was  liable  to  be  affected  every  time  of  its  ap- 
pearance, and  fome  experienced  two  or  three  attacks 
in  the  courfe  of  the  fame  epidemic.  Children  and 
aged  perfons,  in  Europe  as  well  as  America,  were 
peculiarly  exempt. § 

The  diforder  was  moil  fevere  in  thofe  of  bad  habits 
and  impaired  conftitutions.     The  fymptoms  varied  fo 

much, 

*  Duncan's  Inaug.  Biffert.  De  Gatarrho  Epidemico. 

f  This  was  alfo  obferved  in  the  influenza  of  1782.  "  It 
obferved  no  regular  progreifion  from  any  one  point  of  the 
compafs  to  another."     Med.  Tranf.  vol.  iii.  p.  61. 

%  By  a  gentleman  of  information  from  Demerara,  I  am 
Informed,  that  in  1790  and  1793,  the  influenza  made  its  ap- 
pearance in  that  place  alfo— that  the  diforder  was  fevere,  but 
the  event  very  rarely  unfavourable. 

§  Rufh's  Medical  Obfervations  and  Inquiries,  vol.  ii.  p. 
.252. 

"  Out  of  7ooboysinChrift's  Hofpital,  only  14  had  it,  and 
they  in  the  flighteft  manner."    Med.  Tranf.  vol  iii. p.  55. 


(       12       ) 

much,  both  in  the  manner  and  order  in  which  they 
occurred,  that  an  accurate  enumeration  of  them  is  ex- 
tremely difficult.  It  ufually  came  on  with  cold  fhiver- 
ing,  alternating  with  fenfations  of  heat ;  pain  or  fore- 
nefs  in  all  the  limbs,  with  a  difinclination  to  motion; 
obtufe  pain  in  the  forehead,  dizzinefs,  and  vertigo; 
lofs  of  appetite,  naufea,  and  frequently  vomiting.  To 
thefe  fucceeded  a  fenfe  of  heat,  and  fulnefs  in  the  nofe, 
in  moft  cafes,  andfometimes  epiftaxis.  The  eyes  be- 
came ftiff  and  fore,  and  a  difcharge  of  a  thin  acrimoni- 
ous fluid  foon  took  place  from  both  nofe  and  eyes,  fol- 
lowed by  fneezing  and  cough.  The  cough  was  often 
one  of  the  primary  fymptoms:  it  was  generally  at 
firft  dry;  but  as  the  difeafe  advanced,  was  attended 
with  a  copious  expectoration.  It  was  accompanied 
with  difficulty  of  breathing,  unufual  fenfation  of  heat 
in  the  mouth  and  fauces,  hoarfenefs,  frequently  an 
inflammation  of  the  throat,  and  consequent  difficult 
deglutition.  The  fkin  was  dry  and  hot ;  tongue  com- 
monly white  and  moift,  without  much  thirfl ;  fome- 
times  a  diarrhoea  was  prefent,  at  other  times  an  in- 
clination to  coftivenefs,  but  in  general  the  excretions 
were  natural.  A  great  variety  was  obfcrvable  in  the 
pulfe.  It  was,  however,  commonly  at  the  com- 
mencement of  the  difeafe  full  and  foft;  but  often  be- 
came in  a  ihort  time  fmall  and  weak.  There  was  fre- 
quently a  confiderable  degree  of  languor,  laflitude, 
and  depreffion  of  fpirits  from  the  beginning. 

The 


(     i3     ) 

The  fever  increafed  toward  evening:  in  the  night 
delirium  fometimes  came  on ;  but  as  morning  ap- 
proached a  fweat  broke  out,  which  procured  a  remif- 
fion  of  the  fymptoms.  It  feldom  continued  longer 
than  three  days,  and  very  often  not  folong.  With  the 
fever  all  the  other  fymptoms  difappeared,  except  the 
cough,  which  remained  fome  time,  and  then  decreafed 
gradually  ill  frequency  and  violence  until  it  ceafed 
altogether.  As  the  difeafe  receded,  if  convalefcents 
expofed  themfelves  to  the  operation  of  cold  air,  and 
particularly  if  they  wept  abroad  in  cold  damp  wea- 
ther, their  complaints  were  often  renewed  with  in- 
creafed violence. 

The  influenza  was  frequently  much  more  flight 
than  is  here  described:  many  were  not  prevented  by 
it  from  attending  to  their  ordinary  bufinefs;  but  in 
general  it  appeared,  with  fome  variation,  in  the  form 
above-mentioned. 

In  a  number  of  cafes,  and  particularly  w*hen  the 
debilitating  plan  had  been  prettv  liberally  employ- 
ed, all  the  principal  fymptoms  of  typhus  fever  took 
place  in  the  advanced  fhges  and  toward  the  termina- 
tion of  the  complaint. 

Independent  of  the  intervention  of  typhus  fever,  the 
difeafe  fometimes  proves  fatal,  in  old  and  auhmatic 
perfons,  by  inducing  peripneumonia  nctha  or  the  ca- 
tarrhus  fenilis. 

h 


(     H    J 

It  is  alfo  fometimes  attended  with  fatality,  though, 
in  a  more  indirect  manner,  by  haflening  the  approach 
of  phthifis  pulmonalis,  in  perfons  whofe  lungs  are  al- 
ready affected  with  tubercles.  The  cough,  by  agi- 
tating the  lungs  and  exciting  an  inflammation  in  the 
tubercles,  appears  to  be  the  principal  agent  in  produc- 
ing this  effect. 

Repeated  and  long  continued  catarrhal  affections 
may  perhaps  induce  tubercles  in  thofe  predifpofed  by 
their  form  to  phthifis;  but  I  cannot  believe  that  the 
influenza  alone,  as  has  been  afferted  by  fome,  has 
ever  occafioned  it:  and  I  am  the  more  confirmed  in 
this  opinion  by  observing,  that  in  pleurify  the  lungs 
may  be  affected  with  inflammation,  and  at  the  fame 
time  agitated  by  coughing,  without  any  fuch  confe- 
quence  being  produced. 


DIAGNOSIS. 

INFLUENZA,  when  it  has  continued  for  fome 
time,  may  be  diftinguifhed  from  all  other  difeafes, 
hy  the  fymptoms  already  mentioned  ;  but  in  the  be- 
ginning, the  diagnofis  will  be  attended  with  more 
•difficulty,  for  obvious  reafons. 

The  difcafes  with  which  it  is  moft  liable  to  be  con- 
founded are  common  catarrh  and  mealies. 

As  the  fymptoms  of  common  catarrh  bear  a  very 
great  refemblance  to  thofe  which  attend  influenza, 

confidcrablc 


(    i5    ) 

confiderable  attention  is  necefTary  to  make  the  dif- 
tin&ion.  Thev  differ  principally  in  degree.  The 
former  is,  on  its  rlrit  appearance,  generally  unattend- 
ed with  fever;  while,  in  the  latter,  the  febrile  fymp- 
toms  almoft  always  appear  at  the  commencement  of 
the  difeafe,  and  are  more  violent:  the  attack  is  alfo- 
more  fudden.  The  diagnofis  is  not,  however,  of  any 
confiderable  importance,  as  the  mode  of  treatment  in 
both  is  very  fimilar;  and  always  more  fo  in  propor- 
tion to  their  refemblance  to  each  other ;  but  the  na- 
ture of  the  prevailing  epidemic  being  confidered,  there 
will  remain  little  room  for  doubt. 

We  will  alfo  find  much  difficulty  in  diitinguifhing 
It  from  the  meafles,  but  may  fucceed  by  enquiring 
whether  the  patient  ever  had  that  complaint  before, 
and  afcertaining  whether  or  not  it  prevails  in  the 
neighbourhood,  and  whether  he  has  not  been  expofed 
to  the  infection.  If  it  be  the  meafles,  the  iruption  on 
the  fkin  will  foon  afford  a  fufficient  diftindlion.  For- 
tunately, in  this  cafe  alfo,  a  miftake  will  not  be  pro- 
ductive of  any  detriment,  as  the  fame  remedies  which 
are  Serviceable  in  the  one  are  proper  in  the  other. 


PREDISPOSING    CAUSES. 

AS  the  influenza  afFe&ed  both  fexes  and  all  coniti- 
tutions  with  little  or  no  discrimination,  it  appears 
that  no  particular  predifpofition  was  efTentially  necef- 

fary; 


(     i6    ) 

farv;  for  the  robuft  as  well  as  the  delicate,  the 
healthy  as  well  as  the  infirm,*  were  fufceptiblc of  its 
attacks.  As,  however,  there  are  fome  eircurnftances 
which  render  the  body  peculiarly  liable  to  be  af- 
fected by  difeafes  of  this  nature,  and  difpofe  it  to  be 
afflicted  with  greater  violence,  it  will  not  be  amifs  to 
point  them  out,  efpecially  as  by  a  little  attention 
fome  of  them  may  be  readily  avoided. 

Preceding  difeafes,  by  rendering  the  body  debili- 
tated and  irritable,  difpofe  it  to  be  operated  on  by  con- 
tagion, and  may  therefore  with  propriety  be  ranked 
among  the  predifpofing  caufes. 

Large  evacuations,  deprefling  paftions  of  the  mind, 
and  a  fedentary  life  likewife  operate  by  debilitating 
the  fyftem. 

Intemperance,  particularly  in  the  ufe  of  fpirituous 
liquors,  as  alfo  fatigue,  has  a  great  tendency  to  in- 
duce predifpofition---exercife,  moderately  ufed,  in- 
creafes  the  ftrength  of  the  body,  and  is  one  of  the 
be  ft  tonics  employed  in  medicine  ;  but,  when  carried 
to  excels,  it  produces  that  fpecies  of  debility  termed 
by  Brown  indirect.  By  a  fimilar  mode  of  opera- 
tion, 

*  Perfons  laboring  under  other  complaints  are  not  ex- 
empt from  influenza.  When  it  appeared  at  Exeter,  within 
a  w  eek  it  feized  173  perfons  in  the  hofpital. 

44  Thefe  hofpital  patients,  afflicted  with  fuch  various  dif- 
tempers,  and  under  the  operation  of  the  moll  efficacious  me- 
dicines, were  all  affected  almoft  at  the  fame  time  and  in  the 
fame  manner  by  the  influenza."  Dr.  Cummings'acct.  Med. 
Obf.  vol.  vi. — $ee  alfo  Rum's  Obf.  and  Inquir.  vol.  ii. 


(     '7     ) 

tion,  but  in  more  dangerous  degree,  fpirituous  liquors 
prove  detrimental.  We  generally  obferve  intem- 
perate perfons  more  readily  affected  with  contagious 
difeafes  than  others,  and  they  recover  with  greater  dif- 
ficulty. Having  long  been  aecuftomed  to  the  ufe  of 
large  quantities  of  diffufible  ftimuli,  the  remedies 
commonly  employed  are  too  feeble  to  be  of  any  mate- 
rial advantage ;  and  when  the  termination  is  fatal, 
they  may,  with  more  propriety,  be  faid  to  have  fallen 
victims  to  their  own  irregularity,  than  to  the  com- 
plaints which  apparently  produced  their  diffolution. 

Influenza,  approaching  nearly  in  its  nature  to  the 
ordinary  catarrh,  we  may  reafonably  infer,  that  thofe 
caufes  which  occafion  the  one,  will  alfo  have  a  ten- 
dency to  produce  the  other.  Accordingly,  we  find 
that  thofe  who  are  expofed  to  the  night  air,  to  the 
operation  of  cold,  either  alone  or  combined  with 
moiftUre,  or  to  viciflitudes  of  cold  and  heat,  are 
more  particularly  and  more  violently  affected.*  Cold 
proves  evidently  debilitating,  efpecially  when  com- 
bined with  moiflure.  According  to  the  common  opi- 
nion, it  is  injurious  riot  only  by  fimply  diminifhing 
the  excitement,  but  alfo  by  obflructing  the  perfpira- 
tion,  and  determining  from  the  furface  to  the  lungs. 

The  manner  in  which  cold  diminilhes  the  perfpira- 

iion  is  a  fubject  of  confiderable  difpute.    Dr.  Cullen 

C  fuppofes 

*  Cold,    concurring  with   contagion,  renders  it  more 
a&ive.     See  Cullen's  Firft  Lines,  par.  dclxxx. 


(     iS    ) 

fuppofes  It  poffeffed  of  an  afhingent  power,  which, 
producing  a  diminution  of  diameter  in  the  veffels  on 
the  fnrface,  allows  a  fmaller  quantity  of  perfpirable 
matter  to  efcape.  In  paragraph  xc.  of  his  Practice 
of  Phyfic,  he  fays,  "  Befide  the  fedative  2nd  fti- 
u  mulant  powers  of  cold,  it  is  manifeftly  alfo  a  power- 
"  ful  aftringent,  caufing  a  contraction  of  the  veffels 
«;  on  the  furface  of  the  body,  and  thereby  producing 
<<  a  palenefs  of  the  fkin  and  fuppreffed  perfpiration ; 
"  and  it  feems  to  have  fimilar  effects  when  applied 
"  to  internal  parts.  It  is  likewife  probable  that  this 
"  conftriction,  as  it  takes  place  efpecially  in  confe- 
"  quence  of  the  fenfibility  of  the  parts  to  which  the 
"  cold  is  applied,  will,  in  fome  meafure,  be  commu- 
"  nicated  to  other  parts  of  the  body ;  and  that  thereby 
"  the  application  of  cold  proves  a  tonic  power  with 
"  refpeftto  the  whole  fyftem." 

With  deference  to  fuch  refpe£table  authority,  I  can- 
not conceive  cold  poffefTed  of  fo  many  contradictory 
qualities  as  Dr.  Cullen  attributes  to  it.  Indeed, 
that  this  apparently  aftringent  power  depends  on  its 
operation  as  a  debilitant,  appears  to  me  not  impro- 
bable. It  is  a  fa£r,  at  prefent  well  afcertained,  that 
the  fluids  contained  in  the  arteries  are  not  circulated 
through  them  by  the  impulfe  of  the  heart  alone,  but 
that  thefe  veffels  alfo  poffefs  a  power  of  propelling  their 
contents,  fimilar  to  that  with  which  the  heart  is  in- 
dued ;  and,  by  this  mean,  the  circulation  is  carried  on, 

in 


(     «9    ) 

in  the  extreme  vefTels,  in  a  great   meafure    indepen- 
dent of  any  vis  a  tergo. 

This  being  allowed,  it  will  readily  appear  that  cold 
applied  to  the  furface  of  the  hody,  debilitating  thefe 
vefTels,  mnffc  diminim  their  power  of  circulating 
their  contents  ;  in  confequence  of  which  the  quantity 
paffing  through  them  will  be  letfened,  and  a  fmaller 
difcharge  of perfpiration  induced;  the  fluids  not  find- 
ing the  ufual  outlet  at  the  fkin,  a  determination  will 
naturally  take  place  to  the  lungs,  where  there  is  a 
large  extent  of  furface  from  which  they  may  be  dif- 
charged.  At  the  fame  time,  in  confequence  of  the  di- 
mini flied  circulation  in  the  extreme  arteries,  an  accu- 
mulation wili  take  place  in  the  larger  vefTels,  which, 
proving  a  fHmulus  to  them,  and  increafing  their  ac- 
tion, will  induce  the  train  of  febrile  fymptoms  with 
which  catarrh  is  attended. 

Every  thing  that  obftru&s  the  perfpiration  in  any 
conhderable  degree,  produces  a  Umilar  determination. 
Hence  the  remarkable  content  which  fubfifk  be- 
tween the- Jungs  and  furface,  a  diminished  excretion 
from  one  being  fucceeded  by  an  increafed  difcharge 
from  the  other;  and,  on  this  principle,  it  will  fol- 
low, that  in  affections  of  the  lungs,  or  membrane  in- 
vejling  them,  which  arife  from  an  increafed  flow  of 
fluid,  a  determination  to  the  furface  is  one  of  the 
mod  efficacious  and  moft  natural  remedies. 

The 


(     so     ) 

The  operation  of  cold  air,  in  producing  catarrh,  is 
alfo  very  ingenioufly  explained  on  chemical  princi- 
ples. 

In  confequence  of  a  diminution  of  temperature,  the 
atmofphere,  which  is  always  expanded  by  heat,  be- 
comes condenfed  into  a  fmaller  fpace,  and  a  greater 
quantity  than  ufual  is  contained  within  a  given  cir- 
cumference. 

A  perfon,  breathing  this  condenfed  air,  will  in- 
hale a  larger  proportion  of  oxigene  gas,  or  vital  air, 
than  common,  which  will  afford  an  ample  (lock  of 
materials  for  chemical  decompofitions  and  combina- 
tions. 

The  blood  being  highly  oxigenated,  becomes  more 
florid  and  ftimulating;  the  heat  from  the  evolution 
of  caloric,  by  the  decompofition  of  oxigene  gas,  is  al- 
fo increafed,  and,  by  thefe  means,  the  attendant  fe- 
ver of  catarrh  is  formed.  Upon  entering  a  warm 
room,  the  ftimulus  of  external  heat  is  added,  and  a 
fever  more  readily  induced. 

During  the  procefsof  refpiration,  the  water  formed 
in  the  lungs,  by  a  union  of  hydrogene  from  the 
blood  with  oxigene,  is  in  greater  quantity  than  natu- 
ral ;  but  in  confequence  of  the  accumulation  of  heat, 
it  is  difcharged  in  the  form  of  vapour,  and  the  breath 
is  apparently  lefs  moift. 

This  theory  poflefTes  great  ingenuity  and  plaufibili- 
ty,  and  has,  very  probably,  much  real  merit.   On  any 

mode 


C      21      ) 

mode  of  the  operation  of  cold,  if  it  is  fufficient  to  in- 
duce fever,  it  will  augment  the  violence  of  the  influ- 
enza :  as,  in  fuch  cafes,  it  acts  at  nearly  the  fame- 
time  with  the  contagion,  it  is  rather  a  concurring  than 

predifpofing  caufe. 

EXCITING    CAUSE. 

WITH  refpect  to  the  exciting  caufe,  Phyficians 
are  confiderably  divided.  The  principal  opinions  en- 
tertained on  the  fubjecl  are  the  three  following. 

i ft.  That  it  depends  on  a  peculiar  ftate  of  the  air, 
with  refpe£t  to  weight,  moifture,  or  fome  more  in- 
fenfible  qualities.* 

2.  That  it  is  propagated  by  a  particular  contagious 
ftate  of  the  atmofphere.f 

3.  That  it  is  occafioned  by  contagion  but  only 
communicated,  like  the  fmall  pox,  by  intercourfe 
with  the  afFe&ed,  or  through  the  medium  of  fubftan- 
ces  imbued  with  the  contagion. 

As  a   knowledge  of  the  caufes  of  difeafes  is  fre- 
quently effential  and  always  fatisfadtory,  a  more  mi- 
nute 

*  This  opinion  is  ably  and  ingenioufly  fupported  in  an 
inaugural  treatife  on  the  Influenza,  by  Robert  JchnJlo?i,  who 
graduated  at  Philadelphia,  in  1793.  His  publication  acci- 
dentally fell  into  my  hands  juft  as  this  dirTertation  was  go- 
ing to  the  prefs. 

f  The  air  of  places  in  which  the  difeafe  prevails,  is  fup- 
pofed  to  be  impregnated  with  the  contagion  which  is  difperf- 
ed  by  the  winds  to  different  parts,  infecting  them  as  it  paffcs 
along. 


I       21       ) 

ante  inieitigation  of  thefe  opinions   may  perhaps  be 
deemed  neither  impertinent  nor  entirely  ufclefs. 

The  univerfality  of  the  complaint,  the  celerity 
with  which  it  proceeds,  and  the  circumftance  of  per- 
foils  mod  expofed  being  foonefl  and  moft  violently 
attacked,  argue  fuongly  in  favour  of  the  caufes  exit- 
ing in  the  atmefphere  Several  inflances  are  related 
in  proof  of  this  opinion,  of  perfons  being  affected  fe- 
veral  miles  at  fea,  who  had  no  intercourfe  with  the 
land.  But  the  medical  focieties3  which  have  made 
the  moil  accurate  inquiries  into  the  nature  of  this 
complaint,  do  not  confider  thefe  accounts  as  very  au- 
thentic.^ Many  contrary  facls  are  alfo  recorded, 
which  prove  the  regularity  of  progreifion  which  the 
diforder  oonftantly  obferved,  and  which  cannot  be 
reconciled  with  the  opinion  above  mentioned.  It  in 
Ibm^  inftances  raged  in  one  diftrit5t,  while  others  in 
the  neighbourhood  were  entirely  free.f  The  circum- 
ftance of  perfons  being  affected  fooner,  and  with  more 
violence,  who  were  expofed  to  the  air,  is  not  difficult 
Soexplain :  thofe  who  went  abroad  were  more  like- 
ly to  receive  the  infection  from  others  who  had  the 
complaint;  and,  by  being  expofed  to  fudden  changes 
of  the  weather,  which  might  produce  predifpofition, 
uld  become  more  liable  to  be  attacked.  In 
.  as  it  prevailed  equally   in   climates  extremely 

different,, 

*  Medical  Communications,  vol.  i. 
t  Pringie's  account,  Med.  Obf.  vol.  vi. 


(  n  ) 

different,  and  as  its  prcgrefs  was  not  afFecled  by  any  al- 
teration of  weather,*   the  fuppofition  of  its  depending 

on  the  air,  uninfluenced  by  contagion,  does  nor  appear 
to  be  well  grounded.  Irregularities  of  the  atmof- 
phere,  with  re fped  to  weight,  moifture,  &c.  aggra- 
vate the  fymptoms,  but  do  not  feem  to  occafion  the 
diforder. 

It  is  true,  that  by  chemical  changes  in  the  compo- 
nent parts  of  the  atmofphere,  many  difeafes,  for  which 
we  cannot  account,  may  be  induced.  From  fome 
changes  of  this  nature,  the  influenza  may  have  iirft 
originated;  but  I  am  inclined  to  believe,  that  it  is 
continued  at  the  prefent  day  by  means  of  contagion..t 

The  opinion  of  the  contagion's  refidmg  in  the  air, 
is  alfo  liable  to  numerous  objections.  We  cannot 
conceive  it  pofhble,  that  this  contagion,  by  no  means 
the   moil  powerful  with  which  we   are  acquainted, 

fhould 

*  Pringle's  account,  Med.  Cbf.  vol..  vi. 

f  Dr.  Joh-ajlon,  in  the  inaugural  ditTertation  before  referred 
to,  makes  the  following  remark:  "  The  morbific  matter, 
"  exciting  the  difeafe,  muft  have  originated  at  fprrfe  I 
"  and  fome  where;  and  a  caufe,  like "to  that  which  gave  rife 
64  to  it  in  any  one  country,  at  any  one  point  of  time,  might 
"  produce  it  in  another  country,  at  the  fame  time,  under 
"  fimilar  circumilances."  This  obfervation  is  top  exten- 
five  to  have  much  weight.  We  may,  with  equal  propriety 
apply  it  to  the  fmall-pox,  mealies,  plague,  and  ail  other 
contagious  difeafes:  they  muft  have  arifeh  in  the  firfi  ih- 
flance,  independent  of  any  contagion ;  and  the  fame  caufe 
may  recur  in  any  number  of  countries  at  any  time.  This 
is  equally  within  the  bounds  of  polhbilifv  :  we -?.re,  how- 
ever, well  convinced,  that  they  are  at  prefent  entirely  firp- 
ported  by  infedion. 


(       24      ) 

fhould  admit  of  diiFufion  in  a  large  portion  of  atraof- 
phcric  fluid,  without  lofing  its  active  qualities.  We 
arc,  it  is  true,  convinced  by  daily  experience,  that 
large  quantities  of  the  miafma  of  marflies,  may  be 
blended  with  the  air,  or  held  in  folution  by  it,  and  by 
this  mode  of  conveyance,  exert  its  injurious  effects  on 
the  human  body. 

With  the  fource  of  this  miafma  we  are  well  ac- 
quainted, and  know  that  continual  fupplies  of  it  are* 
ccnftantly  furnifhed  by  the  numerous  fens  and  marfhes 
with  which  all  parts  of  the  world  abound.  Yet,  not- 
withstanding this  extenfive,  this  unceafing  fupply,  we 
never  find  the  air  fufficiently  impregnated  to  convey 
it  to  far  and  diftant  parts  in  all  its  native  virulence. 

The  activity  of  the  effluvia  from  marfhes,  feems  to 
be  loft  by  its  being  diffufed  through,  and  diluted  with 
the  innoxious  particles  of  the  atmofphere,  that  in  a 
fhort  time  it  becomes  perfectly  inert.  Thus  it  is  in 
the  vicinity  of  marflies,  of  low  and  wet  fituations,  re- 
plete with  pools  of  ftagnant  water,  where  the  air  is 
loaded  with  perpetual  exhalations,  the  products  of 
heat  and  moifture  operating  on  the  furface  of  the 
earth,  covered  with  putrid  vegetable  and  animal  fub- 
flances :  it  is  in  fuch  places,  and  in  fuch  only,  that 
intermittents    ufually  appear.*     The   inhabitants  of 

the 

*  It  is  not  my  intention  to  maintain  that  intermittents  are 
produced  only  by  marfh  miafma.  It  is,  however,  univer- 
fally  allowed,  that  this  is  the  moft  common  caufe  of  them- 


(      25      ) 

the  adjacent  country,  and  particularly  of  upland  fitua- 
tions,  are  entirely  free  from  all  traces  of  the  com- 
plaint.* 

If  a  miafma  of  this  kind  can  exift  in  the  air,  with- 
out being  injurious  at  any  confiderable  diftance  from 
its  fource,  though  frefti  quantities  are  conftantly  ge- 
nerating ;  it  is  difficult  to  fuppofe  a  contagion  which 
ihall  impregnate  the  air,  fwiftly  paffing  over  places 
in  which  the  difeafe  prevails,  and  when  thus  difFufed, 
preferve  fumcient  activity  to  infect  the  inhabitants  of 
other  parts  over  which  it  glides  with  the  fame  rapidity. 

The  univerfality  of  the  difeafe,  and  the  fwiftnefs  of 
its  progrefs,  can  be  readily  accounted  for  on  the  prin- 
ciples on  which  the  fpreading  of  other  contagious 
complaints  depends.  Even  the  plague,  one  of  the  mod: 
Univerfally  fpreading  difeafes  known,  which  has  thin- 
ned the  inhabitants  of  the  moil  populous  cities,  and 
defolated  the  raoft  fertile  and  thickly  inhabited  coun- 
tries, is,  by  modern  obfervations,  difcovered  to  be  en- 
tirely independent  of  any  ftate  of  the  air,  The  infec- 
tion, which  is  pofTefTed  of  the  higheil  degree  of  viru- 
lence, is,  by  mixture  with  the  atmcfphere,  rendered 
harmlefs  in  a  ihort  fpace  of  time  ;  and  the  diforder  is 
only  propagated  by  fome  direct  mode  of  communica- 
tion ;  in  which  cafe  the  air  immediately  furround- 
ing  only  is  noxious, t 

D  That 

*  Sir  John  Pringle,  page  57. 
f  Cuilen's  Praft.  par.  Ixxxii, 


(     =6     ) 

That  the  contagion  producing  the  plague  does  not 
operate  far  from  its  fource,  is  proved  by  well  attefted 
accounts  of  its  prevailing  on  one  fide  of  a  ftreet,  while 
the  other  is  unaffected,  and  of  the  Europeans  at  Con- 
stantinople efcaping  it,  merely  by  confining  them- 
ielves  to  their  houfes,  and  keeping  up  no  intercourfe 
with  the  other  inhabitants. 

The  fmall-pox  is  another  inflance  of  a  widely 
Spreading  epidemic  produced  only  by  direct  commu- 
nication :  before  the  practice  of  inoculation  was  in- 
troduced, when  it  prevailed  in  any  place,  it  raged  as 
univerfally,  and  was  diffufed  with  as  much  celerity. 

The  whole  catalogue  of  contagious  difeafes  might 
be  brought  forward  to  the  fame  effect ;  and  as  it  is  fa- 
tisfactorily  afcertained,  that  the  molt  active  do  not  im- 
pregnate the  air  to  any  confiderable  diftance,  a  Strong 
prefumption  may  be  formed,  that  the  operation  of 
catarrhal  contagion  is  confined  within  fimilar  limits. 
And  this  prefumption  will  be  further  fubftantiated,  by 
a  conlideration  of  the  manner  in  which  it  proceeded 
in  the  late  and  former  epidemics. 

When  the  influenza  appeared  in  any  place,  it  foon 
became  diffufed  univerfally  round  in  all  the  neighbor- 
ing parts,  without  obferving  any  particular  direction.* 

Sometimes  it  could  be  traced  to  the  arrival  of  per- 
fons  from  fome  place  already  infected. f 

It 

*  Rufh's  Obferv.  and  Inquir.  vol.  ii.  page  256. 
■f  Med.  Tranf.  vol.  hi.     RuftYs  Obf.  and  Inquir.  vol.  ii. 
p.  248. 


(      27      ) 

It  appeared  earlier  in  towns  than  villages-— in 
villages  than  detached  houfes,*  and  in  general  ob- 
ferved  a  regular  and  gradual  mode  of  proceeding. 

The  circumfiance  of  perfons  being  affected  fooner, 
and  with  more  violence,  who  were  expofed  to  the 
air,  is  not  difficult  to  explain :  thofe  who  went  abroad 
were  more  likely  to  receive  the  infection  from 
others,  who  already  had  the  complaint :  by  being  ex- 
pofed to  fudden  changes  of  the  weather,  which  might 
induce  predifpofition,  they  would  alfo  become  more 
liable :  while,  on  the  contrary,  if  it  depended  on 
the  atmofphere,  certainly  this  atmofphere  would  find 
its  way  into  the  houfes  with  the  greateft  facility. 

From  all  thefe  confiderations,  I  am  induced  to  em- 
brace the  opinion,  that  it  is  communicated  in  the 
fame  manner  with  other  contagions,  by  the  fufficient- 
ly  near  approach  to  fome  perfon  labouring  under  the 
difeafe,  or  fome  fubftance  impregnated  with  the 
infection ;  and  that  the  air  has  no  agency  in  the  bu- 
iinefs,  except  a  fmall  portion  of  it  immediately  fur- 
rounding  the  fource  of  the  contagion,  which  is  the 
medium  of  conveyance.!  It  is  well  known,  that  the 
»  halitus 

*  Med.Tranf.  vol.3. 

f  In  this  manner  we  may,  in  fome  meafure,  account  for 
contagious  difeafes  being  frequently  endemic  in  particular 
cities.  A  great  number  of  perfons  having  been  affe&ed,  a 
large  proportion  of  clothing  contains  contagion,  and  fre- 
quently no  inconfiderable  quantity  of  the  atmofphere  is 
impregnated  with  the  effluvia;  much  of  which  being  con- 
fined in  buildings  and  alleys,  where  ventilation  is  but  feebly 


(       28       ) 

lialltus  arifing  from  the  body  of  a  man  in  health,  forms 
a  little  atmofphere  round  him  ;  and  it  is  within  the 
limits  of  this  atmofphere  that  contagion  operates. 

The  peculiar  nature  and  mode  of  operation  of  this, 
and  every  other  contagion,  is  ftill  involved  in  obfcu- 
rity,  and  maybe  ranked  among  thofe  myfleries  of  na- 
ture into  which  the  refearches  of  man  have  not  as  yet 
been  attended  with  fuccefs.  But,  as  the  fcience  of 
chemiftry  is  rapidly  approaching  to  perfection,  and 
has  already  thrown  great  light  on  the  theory  of  me- 
dicine, we  may  entertain  a  hope,  that  thefe,  and  fe- 
veral  other  important  and  obfcure  points,  which  are 
totally  inexplicable  on  the  prefent  medical  theories, 
will,  at  fome  future  period,  be  fatisfa&orily  elucidat- 
ed and  explained  on  chemical  principles.  While, 
therefore,  wTe  are  unable  to  explain  the  caufe,  we 
muft  endeavour  to  obviate  the  effects ;  and,  as  expe- 
rience has  brought  us  well  acquainted  with  them,  we 
may  expect  here  to  meet  with  better  fuccefs. 


PROXIMATE  CAUSE. 

THE  proximate  caufe  appears  to  confift  of  an  in- 
creafed  afflux  of  fluids  to  the  fchneiderian  or  mucous 

membrane 

carried  on,  remains  almoft  ftationary.  In  confirmation  of 
this  remark  it  may  be  obferved,  that  fuch  complaints  rage 
with  moft  violence  in  calm  weather,  and  are  generally  re- 
lieved by  florins  and  high  winds,  which,  on  any  other  prin- 
ciple, would  increafe  the  diforder. 


(       *9       ) 

membrane  already  mentioned— proving  a  fource  of 
irritation  to  it,  and  thus  producing  and  fupporting  the 
fymptoms  which  conftitute  the  difenfe. 

In  fupport  of  this  opinion  it  may  be  obferved,  that 
the  remote  caufes  all  concur  in  occaiioning  an  in- 
ereafed  determination  to  this  part,  and  that  fuch  a  (late 
of  it  is  alfo  evidently  pointed  out  by  the  fymptoms. 

The  contagion  feems  to  pollers  a  peculiar  property 
of  caufing  this  determination,  probably  by  acting  as  a 
famulus  to  the  membrane, when  inhaled  inbreathing, 
independent  of  its  effects  on  the  fyflem  in  general; 
and  it  is  frequently  affiited  by  the  concurring  opera- 
tion of  cold. 


PROGNOSIS. 

IN  a  difeafe  fo  rarely  attended  with  fatality,  the 
doctrine  of  prognofis  porTefTes  no  considerable  degree 
of  importance.  It  is,  however,  of  great  advantage, 
in  the  cure  of  difeafes,  to  have  a  previous  knowledge 
of  thofe  fymptoms  which  may  occur,  as  it  will  enable 
us  either  to  prevent  their  appearance,  or  guard  againil 
their  effects. 

When  the  fever  attending  influenza  is  gentle ;  the 
cough  not  very  troublefome,  and  accompanied  with  a 
free  expectoration ;  refpiration  little  affected,  and  a 
difpofition  to  fweat  manifett,  there  will  be  no  doubt 
of  a  favourable  termination. 

if, 


(     3°     ) 

If,  on  the  contrary,  the  patient's  health  has  been 
injured  by  previous  difcafes;  the  febrile  fymptoms  run 
high,  or  are  followed  fuddenly  by  great  debility;  the 
cough  is  frequent  and  dry,  with  difficult  or  laborious 
rcipi ration;  and  the  patient  is  very  reRlefs  and  afflicted 
with  much  pain,  we  may  expect  a  dangerous  diforder, 
and  perhaps  fear  a  fatal  event.  When  the  perfon  af- 
fected appears  to  be  difpofed  by  his  form  to  phthifis 
pulmonalis,  and  we  have  rcafon  to  fufpect  tubercles 
already  formed  in  his  lungs ;  while,  at  the  fame  time, 
the  fymptoms  are  violent,  and  the  cough  in  particular 
continues  long,  we  have  reafon  to  dread  its  terminat- 
ing in  a  complaint  which  has  as  yet  baffled  the  powers 
cf  medicine. 


METHOD  OF  CURE. 

THE  fever  with  which  influenza  is  attended,  I 

am  inclined  to  believe,  is  commonly  mild  fynochus. 
I  have  heard  of  fome  inftances  in  which  the  inflam- 
matory fymptoms  were  very  great,  at  leafl  the  reme- 
dies ufed  were  fuch  as  could  only  be  ferviceable  in 
high  degrees  of  fynocha  ;  but,  from  the  general  tenor 
of  the  diforder,  and  the  ill  fuccefs  that  too  frequently 
attended  fuch  practice,  I  am  induced  to  conclude  that 
real  cafes  cf  violent  fynocha  very  rarely  if  ever 
occurred. 

Concerning 


I  3*  ) 

Concerning  the  nature  of  fynochus  fever,  Phyfi- 
cians  entertain  very  different  fentiments.  One  party 
fuppofes  that  it  is  induced  by  the  fame  caufes  which 
occafion  fynocha  ;  that  it  is  in  fact  a  real  fynocha  j 
and  that  the.  fymptoms  of  typhus  which  attend  its 
latter  flages,  exift  in  confequence  of  the  previous  in- 
flammatory ftate  being  allowed  to  run  on  to  mdircdt 
debility.* 

The  fupporters  of  the  other  fide  of  the  queftion  af- 
fert,  that  it  is  only  a  variety  of  typhus  fever,  and  that 
the  difference  is  produced  by  the  caufes  of  typhus  ope- 
rating on  a  fyftem  pofTeffed  of  confiderable  vigor,  or 
what  is  termed  a  fthenic  or  phlogiflic  diathehs.  I  con- 
fefs  that  I  am  rather  difpofed  to  fubferibe  to  the  latter 
opinion.  In  confirmation  I  would  obferve,  that  the 
influenza  was  accompanied,  even  at  its  commence- 
ment, with  a  degree  of  languor  and  deprefiion  of  fpi- 
rits,  which  are  never  attendant  on  pure  fynocha  fever: 
and  though  the  pulfe  and  other  fymptoms  were  fuclt 
as  denoted  an  increafe  of  excitement,  which  was  al- 
fo  evidenced  by  the  falutary  effects  of  debilitating;  re 
medies;  yet  this  increafe  was  no  more  than  generally 
attends  the  firft  ftages  of  fynochus :  and  I  think  it 
probable,  that  the  very  near  approach  of  it,  in  fame 
cafes,  to  fynocha,  was  occasioned,  in  addition  to  the 

ithenic 

*  This  appears  to  be  the  opinion  of  Dr.  Rufli,  of  Phils 
delphia;  and  it  was  on  this  principle  that  he  recommended 
blood-letting  and  cathartics  fo  ftrenuoufly  in  the  late  malig- 
nant fever — with  a  view  of  preventing  indirect  debility. 


(    3*     ) 
fthenic  diathefis  of  the  perfon  affec~t.ed,  by  the  excit- 
ing caufes  of  common  catarrh  operating  at  the  fame 
time. 

To  efFc£l  a  cure,  the  excitement  in  the  beginning 
of  the  difeafe  is  to  be  moderated— troublefome  fymp- 
toms  are  to  be  alleviated—and  the  ftrength  of  the  pa- 
tient, which,  toward  the  clofe  of  the  difeafe,  fuffers 
confiderable  diminution,  mould  be  reftored. 

The  firfl  indication— to  moderate  the  excitement, 
is  frequently  the  only  one  neceffary.  It  may  be  fulfilled 
when  the  complaint  is  but  flight,  by  the  ufeof  the  an- 
tiphlogiftic  regimen  only:  indeed,  when  moderate  in 
degree,  the  influenza  generally  yields  to  confinement, 
reft,  and  a  fpare  diet.  It,  however,  often  happens 
that  thefe  are  not  fufhcient,  and  we  mud  then  have 
recourfe  to  more  powerful  means. 

As  it  was  frequently  cured  by  fpontaneous  fweat- 
ing,  fudorifics  are  thus  pointed  out  as  the  natural  and 
mod  proper  remedies.  Emetics,  either  given  in  fuch 
quantities  as  to  produce  full  vomiting,  or  in  naufeat- 
ing  dofes,  are  of  great  ufe,  but  particularly  the  latter. 
They  promote  an  eafy  expectoration,  relieve  the 
cough,  and  at  the  fame  time  determine  to  the  furface. 

The  emetics  in  common  ufe  are,  ipecacuanha,  and 
that  preparation  of  antimony  called  tartar  emetic. 
For  the  purpofe  of  limply  evacuating  the  contents 
of  the  flomach,  I  would  prefer  ipecacuanha,  as 
it  is  moft  gentle ;  and  being  readily  thrown  out  by  the 


(    33    ) 

act  of  vomiting,  the  operation  is  not  increafed  in  vio- 
lence, in  proportion  to  the  quantity  taken  j  but  in  in- 
fluenza, the  emetic  tartar  is  moft  eligible,  as  it  feems 
to  relax  the  fyftem  more  powerfully,  and  can,  with 
greater  certainty,  be  given  in  naufeating  dofes. 

Emetics,  combined  with  opium,  in  the  form  of 
Dover's  powder,  are  alfo  very  ferviceable  as  fudori- 
fics,  efpecially  when  the  warm  bath  is  em-ployed  at 
the  fame  time. 

Warm  bathing  claims  confiderable  merit,  as  it 
proves  powerfully  diaphoretic.  Phyficians  have  been 
over-cautious  in  the  ufe  of  it,  from  an  idea  that  the 
ftimulus  of  the  heat  would  over-balance  the  relaxing 
effects  of  the  moifture  with  which  it  is  combined.  By 
ufing  a  tepid  bath  thefe  objections  will  be  obviated. 

Blood-letting  has  been  confiderably  employed  by 
fome  Phyficians,  and  an  opinion  entertained,  that 
the  influenza  generally  and  almofl  always  required 
this  evacuation.  This  practice  may  have  arifen  from 
the  inflammatory  fymptoms  with  which  it  is  at  firfl: 
attended,  and  particularly  from  die  ftate  of  the  pulfe, 
which  was  frequently  full:  influenced  by  this  ful- 
nefs,  blood-letting  was  largely  prefcribed,  which 
inducing  a  great  degree  of  debility,  was  too  often 
followed  by  death,  or  a  tedious  recovery.  In 
fome  conftitutions,  the  inflammatory  fymptoms  ran 
fo  high,  that  it  was  productive  of  benefit— but 
fuch  inftance?  Were  rare,  and  might,  ino'ft  pro- 
E  bsbly. 


(    3+    ) 
bably,  have  been  relieved  by  lefs  'powerful  and  lefs 
dubious  remedies.'* 

Even  where  the  pulfe  and  other  fymptoms  feemed 
to  indicate  it,  the  nature  of  the  epidemic  being  taken 
into  confideration,  Phyflcians  of  the  greateft  emi- 
nence bled  fparingly  and  with  caution.  From  the 
miftaken  opinions  of  fome,  fatal  confequences  refulted ; 
and  melancholy  fadts  may  be  related  of  perfons,  par- 
ticularly in  the  fouthern  flates,  who  fell  facrifices  to 
the  nfe  of  the  lancet. 

It  may  with  propriety  be  laid  down  as  a  general 
rule,  in  contagious  complaints,  to  be  cautious  of 
bleeding,  as  they  rarely  require,  and  often  will  not 
bear  the  evacuation. 

Blood-letting  may  alfo  have  proved  prejudicial,  in 
violent  attacks  of  the  diforder,  by  not  being  ufed  till 
indirect  debility  was  already  formed,  and  thus  adding 
dire  ft  debility  to  indirect.  Hence  the  impropriety 
of  unneceflfary  delay,  fince  this  remedy  can  only  be 
ufeful  in  the  commencement  of  the  difeafe,  and  at  a 
more  advanced  period  may  prove  highly  prejudicial. 

Cold,  externally  applied,  has  been  recommended 
in  catarrhal  complaints,  but  from  what  has  already 
been  faid  concerning  it,   in  the  former  part  of  this 

dilTertation, 

*  "  It  was  feldom  necelTary  to  take  blood,  fome  were 
relieved  by  it,  but  in  general  it  did  hurt  by  depreffing  the 
patients." — Dr.  White's  account  of  the  influenza,  Med. 
Obf.  vol.  vi. — Dr.Afh's  account,  ibid.— Rum's  Obf.  vol.ii. 
page  259. — Medical  Communications,  vol.  1. 


(  35  ) 
differtation,  it  mud  be  evident  that  I  am  averfe  to  the 
life  of  it.  Whether  it  operates  on  the  furfaee  as  an 
aftringent  or  debilitant,  is  immaterial;  for  as  its  per- 
manent effect  is  to  obftruft  the  perfpiration  and  de- 
termine to  the  lungs,  it  muff  confequently  be  dif- 
ferviceable ;  and  this  opinion  is  fupported  by  facts ; 
for  experience  has  proved,  that,  fo  far  from  being 
ufeful,  an  expofure  to  cold  has  brought  on  a  relapfe 
when  the  difeafe  was  almoft  cured. 

However  objectionable  I  may  confider  the  external 
application  of  cold,  I  am  of  opinion  that  internally  it 
may  be  employed  with  advantage.  It  diminifhes  the 
tone  of  the  fyftem,  and  frequently  proves  powerfully 
diaphoretic,  and  may  with  fafety  be  given  in  every 
cafe  of  increafed  excitement. 

Cathartics  of  a  gentle  kind,  fuch  as  come  under 
the  term  laxatives,  are  very  ferviceable  in  obviating 
coftivene.fs  anddiminifhing  the  fuperabundant  excite- 
ment, and  are  more  fafe  than  the  draft ic,  which  are 
apt  to  prove  too  debilitating. 

The  fecond  indication — to  alleviate  troublefome 
fymptoms,  is  not  productive  of  much  difficulty. 

When  there  is  a  confiderable  fixed  pain  in  any  part 
of  thecheft,  which  is  augmented  by  coughing,  vola- 
tile linament  or  a  bliftering-plaiiler  may  be  applied, 
and  will  generally  remove  it. 

The  cough  'is   commonly  the  moft  troublefome 
fymptom,  and  is  principally  to  be  relieved  by  muci- 
laginous 


(  aft  ) 

taginous  drinks,  which  operate  on  the  fauces,  fheath- 
ing  the  parts  and  defending  them  from  irritation. 
Oily  mixtures  are  alfo  ufed,  but  they  are  apt  to  grow 
rancid,  and  even  if  they  do  not,  are  generally  dif- 
agreeable  to  the  ftomach. 

When  there  is  confiderable  debility,  and  particu- 
larly when  the  patient  is  of  advanced  age,  gum  am- 
moniac, volatile  alkali,  and  other  expectorants  of  a 
fiimulant  nature,  are  preferable.  Opium,  by  allaying 
irritation,  moderates  the  cough,  and  is  raoft  effectual. 
Elixir  paregoric,  combined  with  mucilage,  is  found 
extremely  ufeful,  and  its  utility  is  principally  owing 
to  the  opium  which  enters  its  compofition. 

With  refped  to  the  third  indication — the  ftrength 
of  the  patient  may  be  reftored  in  mod  cafes  by  the 
ufe  of  a  nouriming  diet  only.  When  we  have  reafon 
to  fuppofe  that  this  will  not  be  fufficient,  tonic  reme- 
dies, as  bark,  bitters,  &c.  will  prove  beneficial. 

Where  a  dangerous  degree  of  debility  takes  place, 
the  remedies  found  ferviceable  in  typhus  fever  fhould 
be  employed. 


Previous  to  concluding,  I  cannot  omit  acknowledg- 
ing nvyfelf  highly  indebted  to  Dr.  John  R.  B.  Rod- 
gers,  who,  to  many  ufeful  precepts  which  I  received 
while  under  his  tuition,  has  embraced  every  opportu- 
nity of  adding  the  fervices  of  a  friend.     The  favors 

he 


(    37    ) 
he  has  conferred  are  too  important  to  hefoon  forgotten, 
and  will  ever  intitle  him  to  a  high  claim  on  my  gra- 
titude and  efteem. 

I  am  happy,  alfo>  in  an  opportunity  of  exprefling 
my  grateful  thanks  to  Dr.  Nicholas  Romayne, 
both  for  the  information  I  have  received  from  his  va- 
luable lectures,  and  for  numerous  private  marks  of 
his  friendship* 


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